“Smart Justice”: diverting people with serious mental illness out of jail and into treatment

Jails are a holding ground for the mentally ill. Indeed, these defacto “treatment” facilities hold 10 times as many people with serious mental illnesses as state hospitals.

In 44 states and the District of Columbia, at least one prison or jail holds more people with serious mental illnesses than the largest state psychiatric hospital, according to a report released Tuesday by the Treatment Advocacy Center and the National Sheriffs’ Association.

Across the country, an estimated 356,268 people with mental illnesses including bipolar disorder and schizophrenia are in prisons and jails, compared to just 35,000 in state hospitals — a tenfold difference.


See the full 116-page report dated April 8, 2014 entitled, The Treatment of Persons with Mental Illness in Prisons and Jails: A State Survey.

Information on NJ appears on page 70; NY on page 72.


San Antonio’s novel approach consists of a six-person mental health squad unit that responds to emergency calls in which mental illness may be an issue.

See http://www.kaiserhealthnews.org/stories/2014/august/19/san-antonio-police-treat-mental-health.aspx

These officers seem more like social workers. Stevens says that’s a huge change from his early days on the police force.

“We had absolutely no training 20 years ago in the police academy on how to deal with mental health disturbances,” recalls Stevens.

Is this approach working?

San Antonio and Bexar County have completely overhauled their mental health system into a program considered a model for the rest of the nation. Today, the jails are under capacity, and the city has saved $50 million over the past five years.

What we have here ladies and gentlemen, is “smart justice”, in which “all the players in the system that deal with mental illness – the police, the county jail, mental health department, criminal courts, hospitals and homeless programs – pooled their resources to take better care of people with mental illness.”

Not a terribly novel approach, but a functional adaptation that likely has its roots in “therapeutic jurisprudence”:

Therapeutic jurisprudence is the study of the effects of law and the legal system on the behavior, emotions, and mental health of people. It is a multidisciplinary examination of how law and mental health interact. According to this branch of jurisprudence, the processes used by courts, judicial officers, lawyers and other justice system personnel can impede, promote or be neutral in relation to outcomes connected with participant wellbeing such as respect for the justice system and the law, offender rehabilitation and addressing issues underlying legal disputes. Therapeutic jurisprudence was developed in the late 1980s by Professors David Wexler and Bruce Winick as an academic approach to mental-health law.


See Therapeutic Jusrisprudence and Problem Solving Courts by Bruce Winick, Fordham Urman Law, Vol 30, Issue 3, 2002, Article 4:


What is “novel” is cutting through all the red tape and bureaucracy and actually addressing the elephant in room and coming to grips with the problem; all players agreeing and cooperating and working in a coordinated fashion to resolve a huge systemic problem.

I keep waiting in NY for the Article 10 “players” to address the elephant in room and develop a system that works, that minimizes risk of recidivism, maximizes increased privileges and freedoms to respondents while addressing their needs humanely, ethically, rests upon a treatment methodology with sound empirical backbone, and actually saves the state some money.

A pipe dream?



Leave a Reply

Please log in using one of these methods to post your comment:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s